Measuring and understanding geographic inequities in physician distribution in the Philippines: a multi-method study protocol.

introductionThe Philippines faces physician shortages, exacerbated by their propensity to practise in urban centres. Despite government placement programmes, recruitment and retention of physicians in many areas throughout the country remain difficult. This study aims to: (1) describe the distribution of general physicians and board-certified specialist physicians and (2) identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas with below-optimal physician-to-population ratios in the Philippines. METHODS AND ANALYSIS: To describe the distribution of general physicians and board-certified specialist physicians, we will map Philippine Health Insurance Corporation (PhilHealth)-accredited physicians at the regional and at the provincial level, superimposing medical schools and corresponding training institutions. To identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas of the Philippines with below optimal physician-to-population ratios, we will conduct three rounds of data collection: (1) an online survey of current Philippine Department of Health (DOH)-deployed physicians; (2) online or face-to-face focus group discussions and key informant interviews with a subset of DOH-deployed physicians, senior general and specialist physicians practising in Metro Manila and outside and DOH personnel involved in the implementation of these physician placement programmes at the national, regional and local level; and (3) a stated preference experiment administered to resident physicians of the specialties under study to determine which government interventions can encourage them to establish their practice in areas with lower than optimal physician-to-population ratios in the Philippines. ETHICS AND DISSEMINATION: We have obtained ethics clearance from the Ateneo de Manila University School of Medicine and Public Health Research Ethics Committee. We will disseminate our findings in online or face-to-face dissemination sessions with the DOH, Philippine Health Insurance Corporation, Association of Philippine Medical Colleges, the Philippine Statistics Authority, the Professional Regulation Commission Board of Medicine, the Commission on Higher Education and partner specialty societies. We will also publish our results in peer-reviewed medical or public health journals.